Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Ps Vall d'Hebron 119 AMI-14th Floor, 08035, Barcelona, Spain.
Adv Ther. 2022 Sep;39(9):4037-4051. doi: 10.1007/s12325-022-02256-5. Epub 2022 Jul 25.
Respiratory syncytial virus (RSV)-associated diseases have caused an estimated 1.8 million hospital admissions and 40,000 deaths among children. RSV can cause lower respiratory tract infections (LRTIs) in all age groups, adults with comorbidities, and immunocompromised patients. The aim was to summarize the evidence concerning efficacy and safety of ribavirin in subjects diagnosed with RSV associated with LRTI.
A systematic review and meta-analysis were performed. Eligible studies were observational (> 10 subjects) and randomized-controlled trials of subjects with aerosol/oral ribavirin for RSV-LRTI. Comparator was supportive care or placebo. Systematic search on PubMed, Cochrane Library, and Web of Science databases was conducted between January 2001 and January 2022. PROSPERO register number: CRD42022308147.
After retrieving 907 studies, 10 observational studies and 1 randomized controlled trial were included (4/11 high quality of evidence). Seven studies included subjects with haematological malignancy/stem cell transplant, two lung transplants, and two healthy individuals. A total of 788 subjects diagnosed with RSV infection were included; 14.3% of them presented with only LRTI. Among 445 subjects treated with ribavirin, 195 (43.8%) received an aerosolized formulation. Pooled meta-analysis showed no differences in mortality [risk ratio (RR): 0.63; 95% confidence interval (CI): 0.28-1.42] in all subjects treated with aerosol/oral ribavirin compared to supportive care. In subgroup analysis, mortality was significantly lower in haematological subjects (RR: 0.32; 95% CI: 0.14-0.71), but did not differ significantly in lung transplant recipients (RR: 0.89; 95% CI 0.31-2.56). Oral ribavirin (vs. supportive care) was associated with increased viral clearance (RR: 2.60; 95% CI: 1.35-4.99). Seventeen adverse events were reported among 119 subjects, but none were severe.
Ribavirin should be considered for treatment of RSV-LRTI in haematological subjects. There is a lack of evidence to support its use in lung transplant recipients. Oral formulation appears to be an easier, safe, and cost-effective alternative to aerosolized ribavirin. Further advances needs to focus on newer antivirals.
呼吸道合胞病毒（RSV）相关疾病估计导致 180 万儿童住院治疗和 4 万人死亡。RSV 可导致所有年龄段人群的下呼吸道感染（LRTIs）、合并症患者和免疫功能低下患者的下呼吸道感染。本研究旨在总结利巴韦林在诊断为 RSV 相关 LRTI 的患者中的疗效和安全性证据。
进行了系统评价和荟萃分析。合格的研究为观察性研究（>10 例）和使用雾化/口服利巴韦林治疗 RSV-LRTI 的随机对照试验。对照为支持性护理或安慰剂。在 2001 年 1 月至 2022 年 1 月期间，对 PubMed、Cochrane 图书馆和 Web of Science 数据库进行了系统检索。PROSPERO 注册号：CRD42022308147。
检索到 907 项研究后，纳入 10 项观察性研究和 1 项随机对照试验（4/11 项高质量证据）。7 项研究纳入血液恶性肿瘤/干细胞移植、2 项肺移植和 2 项健康个体的患者。共纳入 788 例诊断为 RSV 感染的患者；其中 14.3%仅患有 LRTI。在 445 例接受利巴韦林治疗的患者中，195 例（43.8%）接受了雾化制剂治疗。荟萃分析显示，与支持性护理相比，所有接受雾化/口服利巴韦林治疗的患者的死亡率均无差异[风险比（RR）：0.63；95%置信区间（CI）：0.28-1.42]。亚组分析显示，血液学患者的死亡率显著降低（RR：0.32；95%CI：0.14-0.71），但肺移植受者的死亡率无显著差异（RR：0.89；95%CI 0.31-2.56）。口服利巴韦林（与支持性护理相比）与病毒清除率增加相关（RR：2.60；95%CI：1.35-4.99）。119 例患者报告了 17 例不良事件，但均不严重。
利巴韦林可考虑用于血液学患者 RSV-LRTI 的治疗。尚无证据支持其在肺移植受者中的应用。口服制剂似乎是雾化利巴韦林的一种更简单、安全、具有成本效益的替代方法。进一步的研究需要集中在新型抗病毒药物上。
